Apparatus for removing blood clots, cataracts and other objects from the eye

ABSTRACT

The invention deals with surgical instrumentation for the removal of generally foreign objects from the eye, including blood clots and the lens of the eye, by inserting a pair of jaws for engaging the object and removing portions thereof as required by movement of the jaws relative to each other.

o United States atem 1 1 1111 3,732,858 Banko 1 1 May 15, 1973 [54]APPARATUS FOR REMOVING BLOOD 2,721,555 10 1955 Jenney ..128/305 CLOTS,CATARACTS AND ()THER 3,173,414 3 1965 0011mm ..128/318 x OBJECTS FROMTHE EYE 1,663,761 3/1928 Johnson ..128/305 2,790,437 4/1957 Moore 1..128/2 Invent Anton Bank", Brooklyn, 2,838,050 6/1958 Ara ..128/310 A Il 1 3,012,323 12/1961 Thompson ..128/276 X [73] sslgnee Corp Long Sland3,144,868 8/1964 Jascalevich 1 ..128/276 x 3,308,828 3/1967 Pippin..128/310 [22] Filed: Feb. 14, 1969 3,477,423 11/1969 Griffith ..128/2pp 799,476 FOREIGN PATENTS OR APPLICATIONS Related U.S. Application Data437,932 11/1926 Germany ..128/305 .N.6228St.1 [63] fgg ifi'g f f gg 2;?o 7 ep Primary ExaminerChanning L. Pace H Attorney-Gordon D. Coplein[52] U.S. Cl. ..128/2 B, 128/305, 128/276 51 int. Cl.....A6lb 10/00,A61b 17/32, A61m 1/00 ABSTRACT [58] Field of Search ..128/2, 276, 305,The invention deals with Surgical instrumentation for 128/3101 303'] theremoval of generally foreign objects from the eye,

including blood clots and the lens of the eye, by insert- [56]References cued ing a pair of jaws for engaging the object and remov-UNITED STATES PATENTS ing portions thereof as required by movement ofthe jaws relative to each other. 1,493,240 Bohn ..128/305 28 Claims, 23Drawing Figures PATENIEDHAYISIUH $732,858

SHEET 1 UF 6 05 1 ZOCUDm IXVENTOR. ANTON BANKO ATTORNEY 385. a #ia a m Dm 2 J wm 50m 25 5 PATENTEU MM 1 5:915

SHEET 2 OF 6 IXVEXTOR. ANTON BANKO AT TORNE Y PAHQI'HLU 3,732,858

SHEET 3 BF 6 8 InN Q I NM FmmL ft w QNQ a r m El He ww k Fm m w I WWATTORNEY PATENIEBHAYISIUTS 3 732,858

SHEET U UF 6 fi f 56b 4% F/ a.

45b 54b 11. #21, 52/9 I ATTORNEY PATENTEDHAY] 5l975 SHEET 5 BF 6 CORNEALIMBUS AQUEOUS ANTERIOR ZONULES O LE POSTERIOR CAPSULE Md POSTERIOR a ICHAMBER ANTERIOR SCLERA w VITREOUS VITREOUS POSTERIOR E MEMBRANE CAPSULEIXVENTOR. ANTON BANKO ATTORNEY PATENTED MY 1 51m a 732 858 SHEET 8 OF 6IXVENTOR. ANTON BANKO W MW ATTORNEY CROSS-REFERENCE TO RELATEDAPPLICATlON This is a continuation in part of applicants copendingapplication Ser. No. 762,286 filed on Sept. 16, 1968, and now US. Patent3,528,425 which issued on Sept. 15, 1970, and which entire subjectmatter of the co-pending application is incorporated herein by referenceas if fully set forth herein and in which applicant discloses the methodand apparatus for forming an opening in the eye for the insertion ofsurgical instrumentation therein for performing surgical procedures.

BACKGROUND OF THE INVENTION The present invention relates generally toimprovements in surgical procedures related to the eye, and moreparticularly to methods and apparatus for the removal of blood clots andother impurities, including the lens from the eye.

The outstanding and unexpected results obtained by the practice of themethod and apparatus of the present invention, are attained by a seriesof features, steps and elements, working together in inter-relatedcombination, and may be applied to biological organisms in general andparticularly the eyes of humans, and hence will be so illustrated anddescribed. The present invention may be used to perform a biopsy at anyportion of the anatomy as well.

Applicant has found that in order to perform various exploratory,diagnostic, or other surgical procedures with respect to the eye, thatit is necessary for an incision or opening to be formed through the wallthereof such that the instrumentation necessary might be insertedtherethrough. When the procedure intended is completed it then becomesnecessary to close the opening and permit the incision in the wall ofthe eye to properly heal such that the eye might function in a propermanner. In applicants co-pending patent application referred to above,the process of forming and closing the opening is disclosed, and whichincision might be formed for use in accordance with the presentinvention. To facilitate the discussion of applicants present inventiondealing with the removal of blood clots or the lens of the eye,reference is made to the copending application to merely illustrate oneform of initial surgical procedure that might be conducted to gainaccess to the interior of the eye for practising the present invention.

By way of illustration and not limitation, once an incision has beenmade and a passageway formed from the exterior to the interior of theeye then a variety of instruments may be inserted within the passagewayto accomplish physical tasks. In accordance with the present inventionthe instrumentation is designed to be inserted through the passagewayfor removing any object or deposit, such as blood clots, tissue andimpurities from vitreous material contained within the eye as well asthe removal of part or all of the vitreous or the lens from the eye andits replacement with another material.

The term object or deposit as used herein is intended to include anyportion of the body that is to be removed partially or entirelytherefrom for whatever purpose it is so desired. By way of example andnot limitation, this may include a blood clot, a growth, such as atumor, or other impurity in the eye, or any other portion of the bodyhowever formed, the the of he eye, healthy, diseased or dead tissue fora biopsy or other reason.

REMOVAL OF BLOOD CLOTS Before proceeding to the details of theinvention, let us first review briefly generally known facts of the eyeand the formation of deposits or objects of which removal thereof isdesired. The retina of the eye is attached to the underlying choroid atthe optic nerve border posteriorly and at the ora serrata anteriorly.Between these two points it is in contact with but not attached to thechoroid. The retina covers the entire imrer aspect of the eyeballposterior to the era serrata. The era serrata is the junction of theretina and the ciliary body, in the average eye it is about 8mmposterior to the limbus. The retina is composed of inelastic nervetissue, consisting of 10 distinct different layers, normally it istransparent, when detached it appears gray. Contained within the eye infront of the retina is the vitreous material in which deposits areformed which may include blood clots, other impurities, as well astissue both healthy or diseased.

Blood clots due to traumatic ruptures of retinal ves sels or othercauses like diabetes, mellitus, hypertension, pen vasculitis or retinaldetachment are often disturbing to the vision. Hemorrhage into thevitreous is an uncommon but serious disorder. There may be sudden andcomplete loss of vision in the affected eye. The blood often remains inthe vitreous for months or forever.

The retina is usually damaged by prolonged intimate contact with bloodelements. If the vitreous clears it is possible that the retina isdetached and vision may be restored by surgical reattachment. Besideblood clots there may be other impurities in the vitreous or aqueoushumor. The humor as a whole can also be spoiled.

At the present time there is no effective, reliable or safe means forremoval of such blood clot deposit known to the applicant. In certainparts of the eye a single small blood clot can not be practicallyremoved from the eye. The exchange of the vitreous as a whole, toapplicants knowledge was never performed routinely. The vitreous is athick transparent gelatinous body which encompasses two-thirds of thevolume and weight of the eye. Because of the high viscosity the vitreouscannot be aspirated through a hypodermic needie with a syringe.

REMOVAL OF LENSES A cataract is an opacity of the lens of the eyerequiring cryosurical techniques to obtain removal of the lens. Thecryoextraction usually requires lens extraction. At the present time,only a congenital, up to the age of 20, cataract can be aspiratedthrough a relatively small incision. Aspiration is possible because ofthe semi-fluidic consistency of the lens.

However when the lens material (cortex and nucleus) is hard and cannotbe aspirated routinely, a 20mm incision is made at about 3mm from thelimbus, the incision runs for from 9 oclock to 3 oclock. There are twoprincipal types of lens extractions intracapsular and extracapsular(just removing lens leaving capsule).

The intracapsular extraction consists in removing the lens within itscapsule, lens and capsule is grasped and pulled gently from the eye.This operation has become the standard cataract procedure.

The extracapsular operation requires a rupture of the anterior portionof the capsule first, the lens cortex and nucleus are removed from theeye leaving the posterior capsule behind, this kind of operation isindicated in some congenital and traumatic cataract. Up to the age oftwenty the lens is attached to the vitreous and intracapsular extractionwill surely lead to considerable loss of vitreous and possibledestruction of the eye.

Prior to the extraction of the lens an enzyme is used, which has aproteinoceous substance that accelerates reaction at body temperature.It has a specifically tie effect on the zonules (tougher at ages 20-50)and so making the removal of the lens much easier. The lens is usuallygrabbed by a special lens capsule forcep or cyro probe and pulled fromthe eye. Sutures are now tied and the anterior chamber is reformed ifnecessary by injection of saline. Occasionally, the cataract operationis combined with corneal transplant, the lens and capsule is removedthrough the front trephine opening of about 8mm diameter. In eachinstance the pupil has to be widely dialated.

OBJECTS OF THE INVENTION An object of the present invention is toprovide an improved method and apparatus for performing surgicalprocedures with respect to the eye and other portions of the anatomy.

Another object of the present invention is to provide an improved methodand apparatus for removing objects from within the eye.

Another object of the present invention is to provide an improved methodand apparatus for the removal of blood clots from the eye in a safemanner.

Another object of the present invention is to provide an improved methodand apparatus for opening the eye and introducing instrumentationtherein and removing the lens of the eye.

Another object of the present invention is to perform a cataractoperation in which the lens is removed and replaced with a fluid.

Other objects and advantages of this invention will become apparent asthe disclosure proceeds.

SUMMARY OF THE INVENTION The present invention is directed to theremoval of objects from humans and animals in vivo by surgicalprocedures s and particularly those in the eye, as by first forming anopening to gain access to the interior thereof and inserting thereinremoval means having a pair of jaws movable relative to each other atsubstantially one end of the removal means. Passage means are providedin the removal means in communicating relationship to the jaws andvented to the atmosphere to provide an exit of the removed materialtherefrom. The jaws are positioned proximate to the object forengagement therewith, which engagement is maintained by providing adifferential pressure at the removal site, either by a venting of thepassage means to the atmosphere, since the pressure within the eye isgenerally greater than the atmosphere it will force the object againstthe jaws and if a viscous material, will effectuate a flow thereof intothe passage means. On the other hand if the object is of a hardenedsubstance then a suction force may be applied through the passage meansto obtain the intimate contact therebetween. Accordingly, the suctionforce may be used even on viscous objects to increase the movementthereof.

Once the object is in place and pressural contact is maintained,relative movement of the jaws is obtained by drive means so as to severany material of the object extending therebetween as the jaws are movedrelative to each other, with the removed material then contained in thepassage means. A suction force may be applied to the passage means toremove the material therefrom.

In accordance with one aspect of the invention the jaws are adapted tobe moved from an open position permitting material to enter the passagemeans, to a closed position substantially preventing material fromentering the passage means.

In accordance with another aspect of the invention the jaws may definecutting edges such as for use in the extraction of the lens and/or thecapsule through a small (2mm) incision at the limbus after the pupil isdilated. The incision may be made with a specially designed two edgedcutter, which produces the same approximate incision every time. Part ofthe anterior capsule may be removed so that the cutting edge can startchopping the softer cortex and later the nucleus and the remainder ofthe capsule or the cutting tip of the instrumentation may be pressedagainst the anterior capsule to cut off part of it first. Theinstrumentation then continues to cut away the lens and the material isremoved, which lens may be replenished with a fluid as a substitutethereof, all in accordance with the invention BRIEF DESCRIPTION OF THEDRAWINGS Although the characteristic features of this invention will beparticularly pointed out in the claims, the invention itself, and themanner in which it may be made and used, may be better understood byreferring to the following description taken in connection with theaccompanying drawings forming a part hereof, wherein like referencenumerals refer to like parts throughout the several views and in which:

FIG. 1, is a somewhat schematic view of a human eye having theinstrumentation inserted therein for removal of a foreign objecttherefrom, in accordance With the present invention;

FIG. 2, is a side view in section of the instrumentation of the presentinvention;

FIG. 3, is an enlarged fragmentary side view in section of the jaws intheir open position;

FIG. 4, is an enlarged fragmentary side view in section of the jaws intheir closed position;

FIG. 5, is a sectional view along the line 5-5 of FIG.

FIGS. 5A, 5B and 5C, are sectional views similar to FIG. 5, illustratingthe progressive movement of the jaws from their open to closed position;

FIG. 5D, is a section view along the line 5D-5D of FIG. 4 andillustrating the jaws in their closed position;

FIG. 6, is a side view substantially in section illustrating anotherform of instrumentation in accordance with the present invention;

FIG. 7, is an enlarged fragmentary side view in section of the jawsillustrated in FIG. 6;

FIG. 8, is an enlarged fragmentary side view in section of the jawsillustrated in FIG. 6 in another position;

FIG. 9, is a sectional view along the line 9-9 of FIG.

FIG. 9A, is a sectional view similar to FIG. 9, showing the jaws in adifferent angular position with respect to each other;

FIG. 9B, is a sectional view along the line 9B9B of FIG. 8, showing thejaws in another angular position relative to each other;

FIG. 10, is an enlarged fragmentary side view in section of another formof jaws in accordance with the present invention;

FIG. 11, is a sectional view along the line l111 of FIG. 10;

FIG. 12, is an enlarged fragmentary side view in section of another formof jaws in accordance with the present invention;

FIG. 13, is a somewhat schematic view of a human eye having theinstrumentation inserted therein for removal of the lens thereof;

FIG. 14, is an enlarged sectional view illustrating the removalprocedure for the eye lens;

FIG. 15, is a further enlarged and fragmentary side view in sectionillustrating the removal process of the lens from the eye;

FIG. 16, is a view similar to FIG. 15, showing the jaws in a differentposition relative to each other; and

FIG. 17, is a view similar to FIG. 15, showing the jaws in a differentposition relative to each other.

PREFERRED EMBODIMENTS OF THE INVENTION Referring now to the drawings andparticularly to FIG. 1 thereof, we see the schematic representation ofan eye 10 having the various portions thereof including a retina 12,choroid and sclera 22. The vitreous body or material 16 is containedwithin the retina 12 and vitreous membrane and is seen to includeforeign objects 18 which may be in the form of blood clots or otherimpurities that are desired to be removed from within the eye 10. Thewall is intended to define any portion of the eye which when piercedwill connect the interior of the eye to the exterior and will generallyinclude all, or portions, of the retina l2, choroid 20 and sclera 22, orthe sclera 22 and ciliary body 24.

Once the blood clot 18 is detected then the surgical procedure isinitiated, which first includes, in accordance with the teaching ofapplicants copending patent application, the forming of an incision oropening 27 in the eye 10, to permit the insertion of instrumentation 30in the form of a probe therethrough to reach the specific area to betreated. The removal process of the foreign object as hereinafterdescribed in greater detail, is capable of being used not only for theeye but for various other operative procedures and uses hereinabovedisclosed, both with the eye and other portions of the anatomy and isaccordingly so described and intended.

Once the opening 27 is formed the instrumentation 30 is inserted thereinsuch that the removal means 31 has its tip or distal end 32 thereof,positioned within the vitreous material 16 contained in the eye 10 toobtain a continuous severing and removal of the blood clot 18 therefrom.

The supporting means 35, which may be of a metallic or thermoplasticmaterial, as seen with respect to FIG. 1, extends through the wall 25and is positioned in and tightened in the incision or opening 27 by adouble mattress suture not shown. The supporting means 35 should havethe ability to rotate within the opening 27. To provide a seal with theremoval means 31 and facilitate its sliding, the supporting means 35should have a minimum outside diameter to be inserted into the incision27, and possibly supported and rotated by a micromanipulator. Finallythe supporting means 35 should eventually provide for an increase involume of the vitreous cavity in order to reduce the pressure in the eye10, during the operation. The supporting means 25 comprises a tubularbody portion 37 which may be of circular cross-sectional area so that itmay be rotatable after it is seated through the wall,25 of the eye 10and includes an opening connecting the interior of the eye to theexterior, and extending from the front end to the rear end thereof.Sealing means 39 is provided in the opening to prevent any of theinternal fluids of the eye from flowing out when the instrument 30extends therethrough. The sealing means 39 may include a sealing member68, which may be in the form of an O-ring to provide the sealingengagement with any element inserted within the opening. Due to theviscosity of the vitreous material a close tolerance at one point in theopening between the removal means and supporting means may be sufficientto provide the sealing engagement.

FIGS. 1 through 5D illustrate one embodiment of the present invention inwhich the instrumentation 30 is illustrated in one form thereof, inwhich the removal means 31 is inserted within the eye 10 and is retainedin position by the supporting means 35 extending through the opening 27in the wall 25, in accordance with applicants copending invention. Oncethe supporting means 35 is placed in position the removal means 31 isinserted through an opening extending therethrough and the exactposition is obtained by the surgeon such that the distal end 32 thereofis placed proximate to the object 18 for engagement with the jaws 36 and38, sometimes referred to as the inner jaw and outer jaw respectivelyfor convenience, of the removal means 31. the removal means 31 is seento include passage means 40 such that when the material is removed fromthe object 18 by the pair of jaws 36 and 38, which are in communicatingrelationship to the passage means 40 at proximately one end thereof, thematerial may be conveniently removed from the removal means 31 which isadapted to be inserted in the body of a human being or other animal invivo.

The removal means 31 includes an elongate inner assembly 42 with acentral longitudinal flow passage 44, which in this embodiment forms thepassage means 40, and extends through an elongated tubular inner jawmember 45 having the jaw or port 36 at its terminal end, and at itsopposite end we have the inner assembly 42 adapted to be releasablyconnected with the lower end of a fluid conducting tube member 46 whichis in communicating relationship with the flow passage 44 by means ofsupply member 48 which is tubular and is interfitted within theconducting member 46 at one end thereof and having a tubular extensionmember 50 between the jaw member 45 and supply member 48, all of whichare in interfitting relationship to each other such that the materialremoved from the object 18 may be moved by various means through thepassage means 40 and eventually removed from the removal means 31.

The removal means 31 further includes an elongate, outer assembly 52rotatably engaged about and extending below the inner assembly 42 andincludes an inner tubular jaw member 54 with a passageway 55 extendingtherethrough and having the jaw or port 38 at its terminal end and atits opposite end connected to a support member 56 which in turn isconnected to a tubular coupling member 58 having a gripping member 60secured thereto as by threads 61 with an annular wall portion 62 havingan opening 63 through which the supply member 48 extends. To facilitatethe angular movement between the jaws a gripping surface 64 which may bein the form of knurling is provided on the exterior of the grippingmember 60.

The gripping member 60 as seen in FIG. 1, may be in part engaged by afinger of the user such that one assembly may be controlled and movedangularly relative to the other since the inner assembly 42 and outer assembly 52 includes mounting means 65 for supporting the respective innerand outer assemblies for relative angular displacement relative to eachother. The mounting means 65 may include axially spaced apart supportmembers or bushings for higher rotatably mounted members, or as in thepresent embodiment it has been found that a minimal spacing between therespective outer diameter of the irmer jaw member 45 and the passageway55 of the outer jaw member 54 is sufficient to permit hand movementtherebetween. The drawings are shown with a slight spacing therebetweenfor convenience in illustration.

To effectuate relative movement drive means 68 is provided such as by acollar 69 secured as by a mounting screw 70 to the supply member 48 andwhich collar 69 may have an outer textured surface 71 such as byknurling such that it may be manually controlled to facilitate itsmovement. As seen in FIG. 1, the fingers of the user grasp the grippingmember 60 and collar 69 and move same relative to each other in anangular plane to obtain revolvment of the jaws 36 and 38 relative toeach other.

As seen particularly in FIG. 2, the respective inner and outerassemblies 42 and 52 are in coaxial alignment with each other andmounting means 65 is provided to keep them relatively spaced for therespective angular rotation or displacement of the jaws 36 and 38relative to each other for material removal as hereafter described. Theouter assembly 52 and inner assembly 48 are shiftable into and out ofregister with the respec tive jaws 36 and 38 upon relative rotation ofthe inner and outer assemblies relative to each other such that theamount of material that is removed may be controlled. The mounting means65 due to the relative slow rotation or angular displacement of theconfiguration shown in FIG. 2, which if manually operated might beanywhere from a fraction of a revolution to several thousand revolutionsper minute, although the respective jaw configuration may be used with apower driven device as hereafter described, such that the dimensionalrelationships of the inner jaw member 36 to the outer jaw member 38 issufiicient to act as the mounting means 65 such that a sliding fit isobtained to permit the angular rotation therebetween.

The related angular movement between the respective inner jaw member 45and outer jaw member 54 is illustrated in FIGS. 3-5D, and as hereafterdiscussed this embodiment of the invention utilizes the principle thatthe respective jaws 36 and 38 are formed such that they may be movedrelative to each other from an open position as seen in FIGS. 3 and to aclosed position as seen in FIGS. 4 and 5D, with the angular changingfrom the open to closed position illustrated in FIGS. 5A, 5B and 5C.

It is appreciated that the actual pressure within the vitreous material16 is greater than that of the atmosphere and accordingly we have adifferential pressure established between the atmosphere and the innerportion of the eye 10. This differential pressure in accordance with thepresent invention may also be established by applying an exterior forceto any portion of the wall 25 of the eye or by applying a suction forcethrough the removal means 31 and through the passage means 40 such as tofacilitate the flow of the removed material within the passage means 40and thereafter from within the removal means 31. The jaws 36 and 38 areshiftable into and out of register with each other such that inpracticing the invention we initially insert the instrumentation 30through an opening formed in the supporting means 35 while the jaws arein their closed position as seen in FIGS. 1 and 2, and maneuver sameuntil the distal end 32 thereof is as seen in FIG. 1 in proximity to theobject 18 which is to be partially or entirely removed therefrom. Theparticular consistency of the object 18 will generally indicate whetherthe respective jaws 36 and 38 define cutting edges, and this will bedependent upon the viscosity of the object which is being encountered.

The jaws 36 and 38, may be formed to define cutting edges for severingor cutting of portions of the object 18 extending therebetween, and asillustrated the outer jaw member 54 has a front end portion 73 having acontoured exterior surface 74 to facilitate its movement through theviscous material 16 and an inner seat 75, shown as a conical depressionfor receiving the complimentary shaped front end portion 77 of the innerjaw member 45 with its conical exterior surface 78 which mates with theseat for coaxial alignment therewith.

The outer jaw member 54 has therein the outer jaw defining opening orport 38 which is in communicating relationship to the flow passageway 55and defines an elongated or oval shaped surface 80 having an outer edge81, and inner edge 82 preferably sharp to define a cutting edge with thesurface 80 inclined upwardly towards the cutting edge 82 from the outeredge 81. The forward extremity of the outer edge 81 or surface 80 shouldbe above the axis of the outer jaw member 54, and preferably a distancerepresented by the dimension X which is at least equal to the wallthickness of the outer jaw member 54, so as to prevent rotation oftissue or other substances pulled by the penetrating point or cuttingedges.

The inner jaw member 45 is similarly formed with the inner jaw definingan opening or port 36 which is in communicating relationship to the flowpassage 44 and defines an elongated or oval shaped surface 85 having aninner edge 86 with a spaced apart outer edge 87 preferably sharp todefine a cutting edge with the surface 85 tapering upwardly from inneredge 86 to the outer edge 87.

To obtain the removal of the object 18 as contained in the passage means40 control means 90 is utilized and is connected to the removal means 31by the conducting member 46. To obtain a differential pressure at theremoval site or passage means a suction force may be applied through theconducting member 46 which is in communicating relationship to thepassage means 40 and the amount of force may be controlled by knob 91such that the removed material is sucked into the control or other meansand disposed of. A fluid supply control knob 92 is illustrated for usewith the embodiment of the invention in which a fluid supply is providedto form a suspension with the removed material to facilitate itsremoval. If fluid is desired in accordance with the embodimentillustrated in FIGS. 1-5D it may intermittently be supplied through thepassage means 40 when the suction is not being applied.

' OPERATION OF APPARATUS IN FIGS. I-SD The instrumentation 30 isadaptable to be used for removing objects 18 having various hardnesscharacteristics, which if viscous, by flowing between the jaws 36 and 38and then separating the mass of the object 18 from itself or the environit is in, or by actually cutting slices thereof for hardened substances.

In accordance with one aspect as illustrated in FIG. 1, the object 18may be of a viscous material, or having a viscosity which is capable dueto the differential pressure either existing or to be established toobtain a flow thereof into the passage means 40. Assuming this to be thecase for viscous materials, the removal means 31 is positionedproximately to the' object 18 and the jaws 36 and 38 are then movedinitially to their open position as seen in FIGS. 3 and by angularrotation of the drive means 68 as illustrated in FIG. 1, from theirclosed to open position, this occurring after positioning-the removalmeans 31 proximate to the object for engagement with the jaws 36 and 38.Either before or upon the jaws reaching their open position we have dueeither to the greater pressure within the eye 10, than in the passagemeans 40 which is in communicating relationship with the atmosphere, adifferential pressure on the object 18 which is sufficient to obtain aflow thereof within the passage means 40 when the jaws are in their openposition such that there is a partial if not entire movement of theobject into the passage means 40. Once all the material of the object 18is in the passage means 40 or the movement of the material has stopped(due to insufficient differential pressure or increased resistance tomotion) then we are affecting relative movement of the jaws 36 and 38from their open moved relative to each other resulting in all or aportion of the object remaining within the passage means 40 when thejaws are in their closed position as seen in FIGS. 4 and 5D. At thisinstance the entire instrumentation might be removed if the amount ofmaterial contained in the passage means 40 is adequate, or the cycle ofrevolving the jaws from the open to closed position may be repeated asoften as required, the entrapped material by adjusting the suction knob91 may remove the material from the passage means 40.

The maintaining of a differential pressure between the passage means 40and essentially the environs of the object 18 is done to retain them insubstantially fixed position to each other during the relative movementof the jaws 36 and 38. The force may be transmitted to the site ofremoval in the direction of arrow 93 by proper coupling of theconducting member 46 to the control means 90 which is shown to includethe knob 91 for controlling suction and another knob 92 for controllingfluid. The fluid control knob 92 is illustrated as being a part of thecontrol means 90 although it is not contemplated for use necessarilywith the embodiment illustrated in FIGS. 1-5D but as hereafter explainedis used with other embodiments of the invention.

The suction means which gives us the suction force is selected dependingupon the viscosity and type of material from which the object is made sothat we are assured of the positioning of the object 18 in abutingrelationship to the distal end 32 of the removal means 31. The suctionforce may be used with a viscous object in that by applying same theremoved material continues to be removed out from within the passagemeans 40 into the control means so that the object contained within thepassage means 40 is continuously moved therealong and does not clog orblock the jaws in their open position.

When the object 18 is of a hardened material or substance such that aflow thereof is not anticipated, or the rate of flow is not sufficient,then it is desired that sharp edges which act as cutting edges 82 and 87of the outer jaw 38 and inner jaw 36 respectively be provided so as toobtain by continued rotation of the inner and outer assemblies 42 and 52respectively by the drive means 68, a progressively contacting, cuttingand removal of material of the object 18 as the jaws are repetitivelyclosed. In this instance the inherent differential pressure may be suchas to obtain a positionment of the object 18 abutting one or both of thejaws 36 and 38 but as the cutting continues it is preferable that asuction force be relied on to retain the object 18 and removal means 31in fixed position to each other. Thus, if the object illustrated in FIG.1, is of a hard material and essentially the removal means 31 ispositioned in its closed position adjacent the object 18 and asdiscussed before the cutting edges 82 and 87 are in communicatingrelationship with the passage means 40 at proximately one end thereof,are then moved from their initially closed position to an open positionto begin the removal process. By applying an ample suction force throughthe passage means 40 to the object 18 it is retained in continuouscontact with one of the jaws 36 and 38 and by affecting relativemovement of the cutting edges 82 and 87 from their open to closedposition they can progressively contact, cut and thereby remove a layerof material from the object 18. The configura-v tion of the jaws as wellas the cutting edges as to both size and configuration will vary withrespect to the size of object to be removed and its hardnesscharacteristics.

The suction force from the control means 90 may be on continuously toboth remove collected material from within the passage means 40 andalways assure a force in the direction of arrow 93 to pull it into andretain it against the jaws when they are in their open position. Thethickness of each successive layer removed may be controlled by thespaced apart dimensional relationship of the cutting edges.

EMBODIMENT AS ILLUSTRATED IN FIGS. 6-9B FIGS. 6-9B illustrate anotherembodiment of the present invention in which the instrumentation 30a hasdrive means 68a that may be operated by an electric motor 95a havingpower leads 96a connected thereto, which instrumentation is utilizedwhen sufficient amounts of the object are to be removed and where theslower manual type of operation is not preferred. This embodiment of theinvention contains jaws 36a and 38a which are of a different form thanthose previously illustrated and as will be illustrated with respect toFIGS. 10-12, but it should be pointed out that same are interchangeablewith the jaws in the embodiment illustrated in FIGS. 1-5D and likewisethe jaws of those illustrated figures may be used with theinstrumentation a illustrated in FIG. 6.

It has been found desirable for certain removal procedures to provide atreatment fluid to the proximate location of the object and whichtreatment fluid is utilized for forming a suspension of the removedmaterial which is then capable of being removed by a suction or otherforce from the removal means 31a leaving the worksite continually freeof the removed material and likewise removing same from the removalmeans. Accordingly, the removal means 31a includes an inner assembly 42aand an elongate outer assembly 52a with a central longitudinal flowpassage 55a which essentially forms the passage means a. The outerassembly 52a includes a longitudinally extending jaw member 54a defininga jaw 38a or port at the distal end 32a thereof, which jaw member 54a issupported at its substantially opposite end by a support member 56ahaving a radial flange 98a for engagement with the support member of theouter assembly 52a. The support member 56a is removably secured at thefront thereof to a threaded portion 99a of housing member 100a which hasa radial flange 101a which abuts up against the front face 102a of thesupport member 56a and having a tubular wall portion 104a defining apassageway 107a which has a downwardly extending tip 104a for sealinglyengaging the outer diameter of the outer jaw member 540 after thelateral port holes 106a, which may be provided to extend through thewall of the outer jaw member 54a. At the opposite end of the housingmember 100a we have a neck portion 108a extending therefrom with aplurality circumferentially spaced apart lateral ports 110a whichcommunicate with the passageway 107a extending between the enclosedouter, portion of the outer jaw member 54a and tubular wall portion 104afor providing a fluid flow channel to the front lateral ports 106:: toobtain a flow in the initial direction of arrow 111a and in thesubsequent direction of arrow 1120, such that a fluid is supplied intothe passage means 40a between the inner assembly 42a and outer assembly52a.

The inner assembly 42a has an inner jaw member a which may be of a rodlike shape with an enlarged jaw head 115a at one end thereof fordefining the jaw 36a with a port extending therethrough between theparallel spaced apart faces 116a thereof, with cutting edges 87aextending along four edges as seen in FIGS. 7 and 8, and hereafterexplained in greater detaiL'The inner jaw member 45a extends from afastener 1 18a and may be integrally formed therewith such that theextension member a to which the fastener is secured is directly coupledto the power drive means 68a, having power cables 96a extendingtherefrom, as by threaded stud 120a. The casing of the drive means 68ahas extending therefrom mounting means 65a in the form of a support arm122a with a threaded portion adapted to receive the connecting member124a which is connected to the tubular coupling member 58a which in turnis secured to'the support member 56a.

To provide the requisite amount of treatment fluid from the controlmeans a fluid conduit 125a is provided and may be coupled to a fluidsupply hose not shown,

and at one end thereof extends exteriorally of the removal means 31afrom the connecting member 124a such that fluid in the direction ofarrow 111a may flow therein and which forward portion of fluid conduit125a extends within support member 56a in communicating relationship atits other end with a fluid supply port 126a within the support member56a which opens into the spacing between the housing member 100a and thesupport member 56a so as to permit the flow into the inlet ports 110a.In like manner the removal means 31a for introducing the suction forcein the direction of arrow 105a to remove the suspension that will beformed in the passage means 40a includes a suction conduit 128aextending exteriorally of and partially through the connecting member124a at one end thereof and at its opposite end coupled to the supportmember 56a and in communicating relationship by the suction port 129a tothe passage means 40a.

in this manner once the instrumentation 30a is positioned in place, in asimilar manner as illustrated with respect to FIG. 1, the respectivejaws 36a and 38a are then adapted to be moved angularly relative to eachother as seen particularly in FIGS. 9, 9A and 98, so that the removal ofall or part of the object can be properly accomplished. The inner jawmember 36a is seen to include an enlarged head portion 115a havingsubstantially parallel faces 116a with a transversely extending openingbetween the faces 116a forming the jaw or port therein and having spacedapart substantially parallel surfaces 85a terminating in cutting edges87a on each side thereof so that it is possible to slice away or cutparticles of the object as they are moved relative to each other. Theend of the outer jaw 3% has a conical pointed seat a which is adapted tosnugly receive the similarly contoured shape in the jaw 36a with theouter assembly 520 having a rounded front end 74a to assist its movementthrough the viscous, or other cellular material, until being positionedproximate to the object from which the material is to be removed.

The jaws 36a and 38a, may be formed to define sharp edges which act ascutting edges for severing or cutting of portions of the objectextending therebetween, and as illustrated the outer jaw member 54a hasa front end portion 73a having a contoured exterior surface 74a tofacilitate its movement through the viscous material and an inner seat75a, shown as a conical depression for receiving the complimentaryshaped front end portion 77a of the inner jaw member 45a with itsconical exterior surface 78a which mates with the seat 75a for coaxialalignment therewith.

The outer jaw member 54a has therein the outer jaw defining opening orport 38a which is in communicating relationship to the passageway 55aand an oblong, elongated or oval shaped surface a having an outer edge81a, and inner edge 82a preferably sharp to define a cutting edge, withthe surface 80a inclined upwardly towards the cutting edge 82a from theouter edge 81a. The inner extremity of the outer member 82a or surface80a should be above the axis of the outer jaw member 54a, and preferablya distance represented by the dimension X which is at least equal to thewall thickness of the outer jaw member 54a, so as to prevent rotation oftissue or other substances pulledby the penetrating point or cuttingedges.

The inner jaw member 45a is similarly formed with the inner jaw definingan opening or port 36a which is in communicating relationship to theflow passage 55a and defines an oblong or elongated shaped surface ahaving parallel spaced apart inner edges 86a with spaced apart outeredges 87a preferably sharp to define a cutting edge with the surface 85atapering upwardly from inner edge 86a to the outer edge 87a.

In order to form the suspension of removed material and fluid, which maybe saline, the fluid may be supplied directly to the chambermeans 40a asillustrated in FIGS. 6 and 7, or directly to the exterior of the removalmeans proximate to the jaws 36a and 38a, or directly to the passagemeans 40a and the removal site simultaneously. If it is desired that thefluid be supplied exteriorally of the removal means 31athen the lateralport holes 106a are adapted to extend through the tubular wall portion104a as seen in FIG. 8, and if simultaneous supply of fluid is desiredexteriorly and interiorly of the passage means 40a then the port holes106a may be provided as in FIGS. 7 and 8.

OPERATION OF APPARATUS IN FIGS. 6-93 In using the instrumentation 30aillustrated in FIGS. 6-9B it will be appreciated that first the removalmeans 31a is inserted such that the jaws 36a and 38a are positionedadjacent the object such that a portion thereof extends between thejaws, and by affecting relative movement of the jaws it is possible tosever any portion of the object extending therebetween as they are movedrelative to each other. The removed material of the object is containedwithin the removal means 31a by entering the passage means 40a. Bymaintaining a differential pressure it is possible to maintain theobject in fixed relationship to the jaws 36a and 38a such that as thecutting is obtained, the object, since it might be situated in a viscousmaterial, is not forced away but is continuously engaged by at least oneof the cutting edges 82a and 87a to progressively remove portionsthereof.

The apparatus illustrated in FIGS. 6-9B is preferably used with ahardened object so that cutting may be facilitated by a static forcebeing applied against the object towards the jaws to retain same incontact therewith. In this embodiment the differential pressure isobtained by using a suction force provided through the suction conduit128a, suction port 129a which is in communicating relationship to thepassage means 40a and in turn the jaws 36a and 38a, so that the objectis continuously pulled between the jaws. Since the device illustrated,as seen in FIGS. 9-9B the inner jaw member 36a will continuously movethrough respective relative positions in a given cycle, and in theposition shown in FIG. 98 has the cutting edge 87a in a parallel planeand adjacent the cutting edge 82a of the outer assembly 52a such thatthe material extending therebetween would be separated and removed asthe angular rotation illustrated in FIGS. 9 and 9A occurs. It is alsopossible by regulating the relative rate of movement between the jaws36a and 38a per a given cycle, as well as the differential pressure byregulating the control means illustrated in FIG. 1, that the amount ofmaterial removed from the object and into the passage means 40a pergiven cycle may be properly controlled. The cycle, which is one completerevolution of the jaws relative to each other, is then repeated as manytimes as required until the amount of the object, which may be in itsentirety, is removed from the body. In this manner by controlling thedifferential pressure it is possible to ob tain a positionment of theobject abutting the jaws 36a and 38a so as to progressively contact, cutand remove the material from the object as the jaws are moved relativeto each other.

By properly controlling the dimensional relationship between the edge82a of the outer jaw 38a to the cutting edge 87a of the inner jaw 36a itis possible to control the amount of removal of the material during therelative movement of the jaw members. One way of specifically doing sameis that by coaxially supporting the jaws 36a and 38a to provide aselected configuration of a given internal cross-sectional area for oneof the cutting edges 82a and providing the other cutting edge 87a with asimilar configuration but of an enlarged'cross-sectional area such thatthe thickness of the layer of material removed is equal to thedifference between the respective cross-sectional areas if both arecircular or the lateral spacing between the cutting edges.

The control means is adapted to continuously supply a fluid to theremoval means 31a to assist in the removal operation of the object. Thefluid which may be in the form of a liquid collapse be provided forvarious reasons, one of which is to replenish the removed material fromthe object as well as any vitreous material lost in the procedure inorder to maintain the internal pressure of the eye to prevent co-lapseof the retina and related portions. The eye has an internal pressure andunless the removed material is replenished there is a tendency for thewall of the eye to collapse which could severely complicate the surgicalprocedure. Another important reason for supplying the treatment fluid isto form a suspension with the removed particles so that they are easilyremoved by suction from the removal means 31a.

Particularly noting FIG. 8, I illustrate an aspect of the invention inwhich if desired the liquid may be supplied exteriorally of the removalmeans 31a and proximate to the object by having the lateral ports 106aextending through the housing member wall 104a such that the treatmentliquid and the suction is applied proximate to the object at spacedapart locations between which at least a section of the removal means31a is interposed so that the suction induces the treatment liquid tomix with the removed material for ensuring the continuous mixing and theremoval of the material. In addition the motion of the fluid will carrythe material between the aws.

In operation the operator after positioning the instrumentation 30a inposition will adjust the fluid control knob on the control means and thefluid from a supply will enter the fluid conduit 125a in the directionof arrow 111a and then by means of fluid supply port 126a and lateralport holes 106a will reach the interior of passage means 40a, theexterior of the removal means 31a adjacent the jaws 36a and 38a, or asexplained above both the interior and exterior. Since the jaws 36a and38a in FIGS. 6-9B are essentially always open the suction force issimultaneously maintained such that a flow pattern is established intothe passage means 40a in the direction of arrow 111a and thereafter outin the direction of arrow 112a through the suction conduit 128a.Simultaneously with the fluid being supplied and suction force appliedthe drive means 68a is operational effecting rotation of the inner jaw36a with the resulting cutting of the object. The motor a of drive means68a may be of a variable speed type which is adjusted by the userdepending on the quantity and type of object being removed. Afterremoving the desired amount the drive means 95a is stopped with thefluid supply and suction being discontinued by adjusting the controlmeans. The removal means 31a is then retracted from within the body andthe opening closed.

OTHER J AW CONSTRUCI'IONS FIGS. 10, 11 and 12 illustrate other alternatejaw construction forms of jaw members that may be used for removal ofthe material as desired. FIGS. 10 and 11, illustrate an inner jaw member36b and outer jaw member 38b with the latter having its outer assembly52b of similar construction to that illustrated in FIGS. 6-93 with theouter jaw member 54b having a front end portion 73b with an inner seat75b, shown as a conical depression for receiving the complimentaryshaped'frontend portion 77b of the inner jaw member 45b with its conicalfrontal exterior surface 78b which mates with seat 75b for coaxialalignment therewith. The inner jaw 36b has its inner jaw member 45bformed having an outwardly radially extending helical groove lb runningessentially the length thereof and having a conical tip 78b at one endthereof such that the cutting edge surface 87b thereof which forms thejaw 36b is seated within the outer assembly 52 b which has the jaw 38bdefining an opening so as to communicate with the passage means b, andas they are moved relative to each other the helical groove l30bcontinues to remove the object which moves along the passage means 40bpermitting the continuous removal of both the material and the liquid.The liquid is supplied by the flow passage 107b which extends betweenthe housing member 100b and outer assembly 52b with the lateral ports10Gb in communicating relationship with the passage means 40b asindicated by the arrow 112b such that the flow of liquid and removedmaterialmixes therein and due to the angular rotation of the innerassembly 42b the removal thereafter occurs. The mechanical structure ofthe drive means for the tools illustrated in FIGS. 10 and 1 1 may be ofthe design illustrated in FIG. 2 and or FIG. 6.

FIG. 12, illustrates another form of the jaws 36c and 386 in which theinner assembly 42c includes a jaw member c having a longitudinallyextending shaft 132: with a chisel point 1330 at one end thereof andhaving circumferentially wound about the exterior surface of the shaft1326 the helical defining groove l30c such that it acts as a pumpingmeans for removal of the material. The outer jaw 38c defining a lateralopening therein with the outer assembly 520 having front end portion 73cwith at least a flat interior surface or seat 750 such that the chiseledge portion 87c abuts it and as the angular movement is obtainedremoval of the object occurs. In like manner fluid may be pumped inthrough the passage means 40c and. by the mixture forming and thepumping action obtained by the helical grooves, the material iscontinuously removed from the removal means 310. This helical mechanismmay provide a controlled method of pumping materials with low viscosity(natural or synthetic vitreous) into the body. To prevent the collapseof the eye this mechanism may be used in that it can supply and removevitreous at a controlled rate.

CATARACT REMOVAL PROCEDURE Before discussing in detail the use of thepresent invention for lens removal it might be best to first review ingreater detail certain known facts to date. A cataract is a lens opacityand to better understand its implications we have to learn more aboutthe lens.

Anatomy of the Lens: The lens is a biconvex almost completelytransparent structure, about 5mm thick and 9mm in diameter. It issuspended behind the iris by the zonular fibers, which connect it withthe ciliary body. The lens is incapsulated in the lens capsule, which isa thin transparent membrane, of which the front part is called theanterior capsule, and the back part is called the posterior capsule.Behind the posterior capsule is the vitreous membrane. The posteriorcapsule and the vitreous membrane are not easily separable in a youngperson. The lens is composed of a central region or nucleus and theperipheral portion is called the cortex, the nucleus is harder than thecortex.

Function of the Lens: The function of the lens is to focus light raysupon the retina. In order to focus light from a distant object, theciliary muscle relaxes, tightening the zonular fibers and reducing thethickness'of the lens to its minimal dimension, in this positionparallel rays are focused on the retina. In order to focus light raysfrom a near object the ciliary muscle releases the tension on thezonules fibers, the lens shapes in a more spherical body increasing itsrefractive power so that the focusing on the retina is again obtained.Composition of the Lens: The lens consists of about 65 percent water andabout 35 percent protein with some trace of minerals).

Cataract: A cataract is a lens opacity. Cataracts vary markedly indegree of opacity, size and location. Cataracts may be due to a varietyof causes but are usually associated with ageing. Most cataracts are notvisible to the casual observer until they become dense enough (mature)to cause blindness.

We have several types of cataracts:

l. A senile cataract is the most common type associated with ageing.After surgery the visual (acuity) improves in ever percent of the cases,the remainder either have pre-existing retinal damage or developpost-surgical complications.

2. Congenital Cataract: They occasionally occur as a consequence ofmaternal rubella during the first 3 months of pregnancy. These cataractsmay cause significant loss of vision, in such event lens extraction byaspiration is done on one eye at the age of 6 months. Surgery on theother eye is performed after the age of two (retina detachment may occurafter several months or years).

3. Traumatic Cataract: Most commonly due to a foreign body striking thelens after passing through the outer structure of the eye, such acataract may also be caused by over-exposure to heat, X-ray, radioactivematerial and ultraviolet exposure.

4. Cataract may also occur as a secondary effect of intraocular orsystemic diseases, as well as a result of some drugs.

Cataract Surgery: In a cataract operation the lens is removed from theeye. At the present time there are two principal types of lensextraction, they are:

l. Intracapsular when the lens is removed together with the capsule,this is a standardized procedure. When the posterior capsule is notattached to the vitreous membrane.

2. Extracapsular extraction is used in congenital and some traumaticcataracts. As we know the posterior capsule may be attached to themembrane and cannot be extracted without rupturing the vitreousmembrane, with serious consequences (vitreous loss, vitreous hemorrhage,retina detachment, etc). For this operation,

the anterior capsule is first ruptured and removed then the cortex andnucleus, leaving the posterior capsule behind.

At the present time a solution of chymotrypsin is injected under theiris. This substance has a lytic (loosening) action on the zonulesmaking easier the removal of the lens. To perform the actual operationof extracting the cataractous lens a conjunctival incision is made 3mmfrom the limbus on an are about 20mm long, extending from 9 to 3o'clock, at 12 oclock a peripheral or full iredectomy is then performedand the lens and capsule is grasped and gently removed from the eye. Theconjunctiva] flap is reapproximated with the sutures. The anteriorchamber is then reformed by injection of soline. If the procedure iscomplicated by vitreous loss, the chances of post operative retinaldetachment, glaucoma, and uveitis are increased.

Post operative care consists in having the eye bandaged for about 2weeks, the patient has to move slowly and avoid any strain for about 4weeks. The material removed from the eye at the present time by theconventional intracapsular cataract operation can now be extractedthrough a l to 2mm incision.

CATARACT PROCEDURE OF PRESENT INVENTION By using the new and novelmethod of the present invention, in accordance with one aspect thereofan intracapsular procedure can be performed, the incision can be made atany convenient place, no iredectomy is necessary for this operation. Theinstrument of the present invention is now inserted into the eye throughthe small incision with the opening at its front, gently pressingagainst the capsule. By rotating the internal cutter jaws, material fromthe capsule and later from the lens is being chopped away from the massto be removed, by carefully orienting the front of the tip it ispossible to reach any remaining portion of the capsule or lens. Whenonly suction is needed the internal cutter jaw is stopped in such aposition not to block the front opening. It is important to emphasizethat only one piece (becoming smaller and smaller) of capsule and onepiece of lens is left in the eye during the operation. The operationcontinues until the whole lens is extracted. Extraction of the posteriorcapsule is optional.

Irrigation of the anterior parts of the eye is necessary to maintain thepressure in the eye above the atmospheric pressure to prevent itscollapsing and to facilitate movement of the chopped material in liquidsuspension from the eye. After the lens and the desired amount ofcapsule is removed, the instrument is extracted and the incision closedwith a single suture as with an ultrasonic or other weld. Post operativecare by use of the present invention is greatly reduced due to thesingle stitch in place of many and the relatively short incision (aboutl/lO to l/lS of the regular one). The possibility of infection andretina detachment is also reduced due to the small incision andmaintained pressure in the eye at all times. The instrument used toperform such a transfusion of relatively dense, high viscosity liquid,may be shown in FlG. 12.

In accordance with another aspect of the invention an extracapsular canbe performed in which a different procedure is used so that the capsuleshould remain in the eye. For such a case a 20mm incision on the outerwall of the eye is needed to be able to reach the anterior capsule withthe instrument. A l-2mm incision is now made on the anterior capsulethrough which the instrument is now inserted. The material to be removedis now the lens alone which is being chopped by the instrument, parts ofthe lens are now removed as previously described until the entire lensis extracted. By keeping the liquid pressure in the capsule the lenswill practically float in it and will be kept adjacent to the cuttinginstrument by the force of the moving liquid as well as by thedifferential pressure which generates this flow. As described previouslythe remainder of the lens in the capsule is always confined in one piecewhich is getting smaller and smaller during the operation until the lastpiece is being removed. After the operation the instrument is extracted,or while in position the capsule may be refilled with a specific naturalor artificial liquid to replace the lens, the instrument shown on FIG.12, can be used to inject or drive into the capsule liquid of highviscosity, the capsule now has to be closed by a suture or by anultrasonic or other weld. The outer incision is also closed by suturesor weld, the anterior chamber reformed and if everything went asexpected no glasses or contact lenses will be needed.

FIGS. 1347, illustrate the use of the apparatus generally seen in FIGS.6-9B for cataract surgery, within the eye 10d, and in which we have theremoval of an object of high viscosity or hardened material requiring acontinuous cutting and removal as described. The use of the inventiontakes into consideration the desirability of maintaining the pressureconstantly above the atmosphere within the eye chamber or capsule suchthat it does not collapse as the lens is gradually removed during theoperation. It is possible to maintain the pressure by retaining thevolume of material within the eye chamber or capsule constant such thatwe have an equal volume of liquid therein. The incoming liquid has toreplace the liquid being lost through the incision and the materialbeing removed in subsequent removal steps. The operation includesforming an incision, if desired using the supporting means illustratedin FIG. 1 in conjunction with a double mattress suture which is used totighten the eye wall around the tip to maintain the pressure in the eyeand prevent appreciable amounts of liquid looses through the incisionwith consequent increase in flow into and through the eye in which casethe streaming of the liquid may cause damage to the single layer ofcells of the inner surface of the cornea forming the endothelium. Bythis surgical procedure it is possible to maintain the lens material tobe removed by suction and force of moving liquid in contact with theremoval means 31d between each successive cut. Once the instrumentation30d is embedded within the lens material 18d, and as seen in FIGS. 15,16 and 17 by utilization of the suction force we have a portion of thelens 18d extending between the jaws 36d and 38d and within the openingof the inner jaw 36d. Once the object 18d is positionedas seen in FIG.15 and the angular movement between the respective jaw members 36d and38d is obtained we have a continued slicing of particles and removalthereof. As indicated above a fluid is used and accordingly we may havethe exterior port holes 106d as indicated by arrow 112d providing aliquid medium within the eye chamber or capsule such that it assists inthe formation of a liquid suspension which is easily removable bysuction means transmitted to the removal means 31d as hereinabovedescribed.

For the extracapsular procedure, once the opening is formed in theanterior capsule and the instrument is inserted, a differential pressureis applied as by combined suction and pressure of incoming liquid, theinstrumentation 30d is moved forwardly into the lens such that thedistal end 32d thereof and particularly the jaws 36d and 38d come incontact with the material and when the static pressure in the capsule issuch to force liquid in between the lens and the capsule thisfacilitates limited motion of the lens in the capsule even at thebeginning of the operation such that the lens almost somewhat floats andis separated from the capsule. The vacuum in the passage means 40dcauses the lens material 18d to remain adjacent to the cutting edges 82dand 87d to shear the lens mass when exposing it to the rotating cuttingedges such that consequentially the edges cut a slice of the mass of thelens 18d and continues to remove same into the passage means 40d. Asthis operation continues it can easily be appreciated that the entiremass can be removed.

An important aspect of the present invention is the fact that it ispossible to remove the lens alone without actually engaging or damaging,except for a small minimal opening formed of perhaps 2 millimeters, theanterior capsule. By being able to remove the inner core withoutphysically damaging the exterior capsule it becomes possible to replacethe lens material with a liquid material that would permit the sametransparency such that it would not be necessary to remove the actualcapsule itself. This is most important in that if the remaining portionsare kept in tact and the zonules has remained in functioning conditionthen by replacing the lens material with another type of material aperson can continue to use same as he had before without having toresort to contact lenses and this is substantially importantAccordingly, supply means 135d, which may be represented by FIG. 12, maybe inserted into the anterior capsule and by conventional control meansassociated therewith (not shown) replenish the removed lens at a speedequal to the removal rate to thereby obtain a complete transfusion ofthe lens with a liquid.

CONCLUSION The above discussion clearly indicates that the presentinvention may be used for the removal of a variety of objects fromhumans or animals in vivo as desired, 1

and particularly is related to the areas associated with the eye in viewof the unique characteristics and problems associated such as that thepressure should be accounted for and retained. This differential ofpressure between the exterior and interior of the eye also lends itselfto assist in the actual process as well as create the unique problemsassociated therewith. Accordingly, the instrumentation is adaptable tobe used herein by those skilled in the field for removal of selectobjects as desired and at rates that are appropriate for the portioninvolved. This permits the insertion of the instrumentation, itspositioning and remaining in a given region until removed from theopening, which opening is then closed in a conventional manner.

In particular with respect to cataract removal we have the uniqueability if desired to permit the lens capsule to remain in tact whileremoving the lens therefrom. It should be pointed out that this abilitysubstantially lessens the dangers associated therewith and particularlyincreases the comforts to the individual who is operated on in thisprocedure.

Although illustrative embodiments of the invention have been describedin detail herein with reference to the accompanying drawing, it is to beunderstood that the invention is not limited to those preciseembodiments, and that various changes and modifications may be effectedtherein without departing from the scope or spirit of the invention,except as defined in the appended claims.

I claim:

1. Apparatus for cutting and then removing material from a portion ofthe body of a human being or other animal in vivo comprising v elongatedremoval means adapted to be inserted within said body portion, saidelongated removal means formed with at least one passage through aportion thereof and having a pair of jaws located in proximity to and incommunication with one end of said passage at the operative end of theremoval means with the other end of said passage exiting from theremoval means, at least one of said jaws having cutting means thereon,

means for mounting said jaws such that one is rotatable relative to theother to cut the material from the body while said removal means islocated therein,

and means connected to said removal means for providing a suction forcein said passage, said jaws being formed to present an opening at theoperative end of the instrument during a portion of arc of rotation ofone jaw relative to the other to bring by the action of the suctionforce the material being removed in proximity to said pair of jaws forcutting thereby, the material cut by said jaws being conveyed by thesuction force through the exiting end of the passage while said removalmeans is still located in the body.

2. Apparatus as defined in claim 1, and further including drive meansoperatively associated with said removal means for rotating said jawsrelative to each other.

3. Apparatus as in claim 1 wherein said removal means comprises twoelongated members located one within the other, a jaw being formed atthe free end of each said member, one of said members having an openingfor communicating with said passage, and means for angularly rotatingone of said members relative to the other.

4. Apparatus as in claim 1 wherein said members are rotatable by saidrotating means for 360 relative to each other.

5. Apparatus as in claim 1 further comprising mean for supplying fluidthrough a said passage proximate to said jaws.

6. Apparatus as in claim 4 wherein one of said elongated members isformed to define the passage for the suction force. I

7. Apparatus as in claim 4 further comprising means for moving one ofsaid members axially relative to the other to control the cutting actionof said jaws.

8. Apparatus as defined in claim 1 wherein at least one of said jaws hasan opening therein and said jaws are adapted to be moved from an open toa closed position, permitting material to enter said opening in saidopen position and substantially preventing material from entering saidopening in said closed position.

9. Apparatus as defined in claim 1 wherein said removal means includes:

a. an elongate inner member with a central longitudinal opening formingsaid passage, a conduit member communicating with the flow passage,

b. an inner jaw adjacent one end of said inner member communicating withthe flow passage,

c. an elongate outer member rotatably mounted aboutthe inner member, and

d. an outer jaw adjacent one end of said outer member and shiftable intoand out of register with said inner jaw in the inner assembly uponrelative rotation of said inner and outer members.

10. Apparatus as defined in claim 9, wherein both jaws are formed withopenings, the relative crosssectional areas of the openings of said jawsbeing such that when in their open position with their openings inregister with each other, material may enter said passage means, andwhen in their closed position with their openings out of register witheach other they substantially seal ofi said passage means and preventmaterial from entering therein.

11. Apparatus as defined in claim 9, wherein the forward end of saidouter member defines a tapered configuration to facilitate penetrationwithin the body by said removal means.

12. Apparatus as defined in claim 9,

a. wherein said jaw of said outer member defines an opening having anelongated shaped surface with an outer edge and spaced apart inner edge,said surface inclined upwardly from said inner edge to said outer edge,and the forward extremity of said outer edge extending above the axis ofsaid outer member by a distance at least equal to the wall thickness ofsaid outer member jaw so as to prevent rotation of said object by therotation of the inner member jaw relative to the outer member jaw, andwherein said inner member jaw defines an opening having an elongatedshaped surface with an outer edge and a spaced apart inner edge, saidsurface inclined upwardly from said inner edge to said outer edge, and

c. at least one edge on each of said jaws defining a cutting edge forsevering the object extending therebetween.

13. Apparatus as defined in claim 1, wherein said removal meansincludes:

a. an elongate outer member with a central, longitudinal opening formingsaid passage, means on said outer member to connect with a conductingmember, said conducting member communicating with i the flow passage,

b. an outer jaw adjacent one end of said outer member communicating withthe flow passage,

c. an elongate inner member extending within said outer member forangular displacement relative thereto, and

d. an inner jaw at substantially one end of said inner member andshiftable into and out of register with the outer jaw upon relativerotation of said inner and outer members.

14. Apparatus as defined in claim 13, wherein said outer member jawdefines an opening having an elongated shaped surface with an outer edgeand spaced apart inner edge, said surface inclined upwardly from saidouter edge to said inner edge, with at least one of said edges defininga cutting edge, and the forward extremity of said inner edge extendingabove the axis of said outer member by a distance at least equal to thewall thickness of said outer member jaw so as to prevent rotation of theobject by rotation of the inner jaw.

15. Apparatus as defined in claim 13,'wherein said inner member jawdefines a head portion having substantially parallel spaced apart faceswith a transversely extending opening therebetvveen defining one or morespaced apart cutting edges at said faces.

16. Apparatus as in claim 1 further comprising means as part of saidelongated removal means for supplying a second fluid to exit from theoperative end of said removal means to the portion of the body fromwhich the material is being removed.

17. Apparatus as in claim 16 wherein said fluid supply means includes apassage formed in said elongated removal means which is separate fromthe passage through which said suction force is provided.

18. Apparatus as in claim 16 wherein said fluid supply means includesthe same passage through which said suction force is provided.

19. Apparatus as in claim 1 wherein said removal means comprises twoelongated tubular members located one within the other, means formounting said members for relative angular rotation with respect to eachother, each of said members having an opening at the free end thereof atleast a portion of which can be brought into, registration with theopening of the other member, at least one of said members being formedwith a cutting means surrounding at least a portion of its opening sothat upon angular rotation of the members relative to each othermaterial which is located in the path between said cutting means andthesurface surrounding the other opening will be cut.

20. Apparatus as in claim 19 wherein one of said elongated tubularmembers defines the passage which is in communication with said meansfor applying said suction force.

21. Apparatus as in claim 1 wherein said removal means comprises a firstelongated tubular member forming a fluid flow passage and having anopening in proximity to one end thereof, jaw means formed at said oneend of said first member, a second elongated member having jaw means atone end thereof, one of said jaw means being formed with cutting meansand defining with the jaw means of said other member a cutting surface,and means for mounting said first and second members for relativerotation with respect to each other.

22. Apparatus as in claim 21 further comprising a second tubularelongated member forming a second fluid flow passage, said secondtubular member having an opening adjacent the end thereof at theoperative end of the elongated removal means which communicates withsaid fluid flow passage defined by said member.

23. Apparatus as in claim 21 wherein said second elongated member has aknife blade at the end thereof which defines its jaw and coacts with thejaw means of said first elongated member.

24. Apparatus as in claim 23 wherein said second elongated member has adouble faced knife blade.

25. Apparatus as in claim 22 wherein said second elongated memberincludes a helical cutting surface, the end of said surface defining thejaw means of said second member, which jaw means coacts with the jawmeans of said first member to cut the material, said cut material beingremoved by said helical surface.

26. Apparatus as in claim 21 further comprising motor means for rotatingsaid first member relative to said second member.

27. Apparatus for removing an object from within the eye of a humanbeing or other animal in vivo, comprismg:

A. removal means adapted to be inserted within said eye and including:

a. an elongate outer assembly with a central flow passage formingpassage means, with an outer jaw substantially at one end of said outerassem bly connected to the flow passage, and

b. an elongate inner assembly extending within said outer assembly forangular displacement relative thereto, with an inner jaw atsubstantially one end of said outer assembly and shiftable relative tosaid outer jaw upon relative rotation of said inner and outer assembly,

0. said outer jaw defines opening having an elongated shaped surfacewith an outer edge and spaced apart inner edge, said surface inclinedup-' wardly from said outer edge to said inner edge, with at least oneof said edges defining a cutting edge, and the forward extremity of saidinner edge extending above the axis of said outer assembly by a distanceat least equal to the wall thickness of said outer jaw so as to preventrotation of the object by rotation of the inner jaw, and

d. said inner jaw defines a head portion having substantially parallelspaced apart faces with a transversely extending opening therebetweendefining spaced apart cutting edges at said faces,

B. mounting means within said removal means for supporting said innerand outer assembly for relative angular displacement relative to eachother so C. means for maintaining a suction force in said passage meansto maintain said object in a substantially fixed position relative tosaid jaws, said suction force being applied through said passage meansto said object,

D. means for forming a fluidized suspension of said removed material bysupplying a treatment fluid proximate to said jaws, and

E. means for removing said fluidized suspension from said passage means,said means including suction means connected to said passage means forremoval of said fluidized suspension therefrom.

28. Apparatus for performing eye surgery in a human being or otheranimal in vivo, comprising:

A. means for progressively removing the lens of the eye from within itscapsule, said removal means including passage means and a pair of jawsconnected thereto at proximately one end thereof, said jaws adapted tobe moved relative to each other, and

B. means for maintaining a suction force in said passage means to retainsaid lens in substantially fixed position relative to said jaws,

C. means for effecting relative movement of said jaws so as to sever thematerial of the lens extending therebetween as they are moved relativeto each other, said removed lens material being contained within saidpassage'means, and

D. means for supplying a fluid internally to said capsule to preventcollapse thereof during removal of said lens.

1. Apparatus for cutting and then removing material from a portion ofthe body of a human being or other animal in vivo comprising elongatedremoval means adapted to be inserted within said body portion, saidelongated removal means formed with at least one passage through aportion thereof and having a pair of jaws located in proximity to and incommunication with one end of said passage at the operative end of theremoval means with the other end of said passage exiting from theremoval means, at least one of said jaws having cutting means thereon,means for mounting said jaws such that one is rotatable relative to theother to cut the material from the body while said removal means islocated therein, and means connected to said removal means for providinga suction force in said passage, said jaws being formed to present anopening at the operative end of the instrument during a portion of arcof rotation of one jaw relative to the other to bring by the action ofthe suction force the material being removed in proximity to said pairof jaws for cutting thereby, the material cut by said jaws beingconveyed by the suction force through the exiting end of the passagewhile said removal means is still located in the body.
 2. Apparatus asdefined in claim 1, and further including drive means operativelyassociated with said removal means for rotating said jaws relative toeach other.
 3. Apparatus as in claim 1 wherein said removal meanscomprises two elongated members located one within the other, a jawbeing formed at the free end of each said member, one of said membershaving an opening for communicating with said passage, and means forangularly rotating one of said members relative to the other. 4.Apparatus as in claim 1 wherein said members are rotatable by saidrotating means for 360* relative to each other.
 5. Apparatus as in claim1 further comprising mean for supplying fluid through a said passageproximate to said jaws.
 6. Apparatus as in claim 4 wherein one of saidelongated members is formed to define the passage for the suction force.7. Apparatus as in claim 4 further comprising means for moving one ofsaid members axially relative to the other to control the cutting actionof said jaws.
 8. Apparatus as defined in claim 1 wherein at least one ofsaid jaws has an opening therein and said jaws are adapted to be movedfrom an open to a closed position, permitting material to enter saidopening in said open position and substantially preventing material fromentering said opening in said closed position.
 9. Apparatus as definedin claim 1 wherein said removal means includes: a. an elongate innermember with a central longitudinal opening forming said passage, aconduit member communicating with the flow passage, b. an inner jawadjacent one end of said inner member communicating with the flowpassage, c. an elongate outer member rotatably mounted about the innermember, and d. an outer jaw adjacent one end of said outer member andshiftable into and out of register with said inner jaw in the innerassembly upon relative rotation of said inner and outer members. 10.Apparatus as defined in claim 9, wherein both jaws are formed withopenings, the relative cross-sectional areas of the openings of saidjaws being such that when in their open position with their openings inregister with each other, material may enter said passage means, andwhen in their closed position with their openings out of register witheach other they substantially seal off said passage means and preventmaterial from entering therein.
 11. Apparatus as defined in claim 9,wherein the forward end of said outer member defines a taperedconfiguration to facilitate penetration within the body by said removalmeans.
 12. Apparatus as defiNed in claim 9, a. wherein said jaw of saidouter member defines an opening having an elongated shaped surface withan outer edge and spaced apart inner edge, said surface inclinedupwardly from said inner edge to said outer edge, and the forwardextremity of said outer edge extending above the axis of said outermember by a distance at least equal to the wall thickness of said outermember jaw so as to prevent rotation of said object by the rotation ofthe inner member jaw relative to the outer member jaw, and b. whereinsaid inner member jaw defines an opening having an elongated shapedsurface with an outer edge and a spaced apart inner edge, said surfaceinclined upwardly from said inner edge to said outer edge, and c. atleast one edge on each of said jaws defining a cutting edge for severingthe object extending therebetween.
 13. Apparatus as defined in claim 1,wherein said removal means includes: a. an elongate outer member with acentral, longitudinal opening forming said passage, means on said outermember to connect with a conducting member, said conducting membercommunicating with the flow passage, b. an outer jaw adjacent one end ofsaid outer member communicating with the flow passage, c. an elongateinner member extending within said outer member for angular displacementrelative thereto, and d. an inner jaw at substantially one end of saidinner member and shiftable into and out of register with the outer jawupon relative rotation of said inner and outer members.
 14. Apparatus asdefined in claim 13, wherein said outer member jaw defines an openinghaving an elongated shaped surface with an outer edge and spaced apartinner edge, said surface inclined upwardly from said outer edge to saidinner edge, with at least one of said edges defining a cutting edge, andthe forward extremity of said inner edge extending above the axis ofsaid outer member by a distance at least equal to the wall thickness ofsaid outer member jaw so as to prevent rotation of the object byrotation of the inner jaw.
 15. Apparatus as defined in claim 13, whereinsaid inner member jaw defines a head portion having substantiallyparallel spaced apart faces with a transversely extending openingtherebetween defining one or more spaced apart cutting edges at saidfaces.
 16. Apparatus as in claim 1 further comprising means as part ofsaid elongated removal means for supplying a second fluid to exit fromthe operative end of said removal means to the portion of the body fromwhich the material is being removed.
 17. Apparatus as in claim 16wherein said fluid supply means includes a passage formed in saidelongated removal means which is separate from the passage through whichsaid suction force is provided.
 18. Apparatus as in claim 16 whereinsaid fluid supply means includes the same passage through which saidsuction force is provided.
 19. Apparatus as in claim 1 wherein saidremoval means comprises two elongated tubular members located one withinthe other, means for mounting said members for relative angular rotationwith respect to each other, each of said members having an opening atthe free end thereof at least a portion of which can be brought intoregistration with the opening of the other member, at least one of saidmembers being formed with a cutting means surrounding at least a portionof its opening so that upon angular rotation of the members relative toeach other material which is located in the path between said cuttingmeans and the surface surrounding the other opening will be cut. 20.Apparatus as in claim 19 wherein one of said elongated tubular membersdefines the passage which is in communication with said means forapplying said suction force.
 21. Apparatus as in claim 1 wherein saidremoval means comprises a first elongated tubular member forming a fluidflow passage and having an opening in proximity to one end thereof, jawmeans formed at said one end of said first member, a second elongatedmember havIng jaw means at one end thereof, one of said jaw means beingformed with cutting means and defining with the jaw means of said othermember a cutting surface, and means for mounting said first and secondmembers for relative rotation with respect to each other.
 22. Apparatusas in claim 21 further comprising a second tubular elongated memberforming a second fluid flow passage, said second tubular member havingan opening adjacent the end thereof at the operative end of theelongated removal means which communicates with said fluid flow passagedefined by said member.
 23. Apparatus as in claim 21 wherein said secondelongated member has a knife blade at the end thereof which defines itsjaw and coacts with the jaw means of said first elongated member. 24.Apparatus as in claim 23 wherein said second elongated member has adouble faced knife blade.
 25. Apparatus as in claim 22 wherein saidsecond elongated member includes a helical cutting surface, the end ofsaid surface defining the jaw means of said second member, which jawmeans coacts with the jaw means of said first member to cut thematerial, said cut material being removed by said helical surface. 26.Apparatus as in claim 21 further comprising motor means for rotatingsaid first member relative to said second member.
 27. Apparatus forremoving an object from within the eye of a human being or other animalin vivo, comprising: A. removal means adapted to be inserted within saideye and including: a. an elongate outer assembly with a central flowpassage forming passage means, with an outer jaw substantially at oneend of said outer assembly connected to the flow passage, and b. anelongate inner assembly extending within said outer assembly for angulardisplacement relative thereto, with an inner jaw at substantially oneend of said outer assembly and shiftable relative to said outer jaw uponrelative rotation of said inner and outer assembly, c. said outer jawdefines opening having an elongated shaped surface with an outer edgeand spaced apart inner edge, said surface inclined upwardly from saidouter edge to said inner edge, with at least one of said edges defininga cutting edge, and the forward extremity of said inner edge extendingabove the axis of said outer assembly by a distance at least equal tothe wall thickness of said outer jaw so as to prevent rotation of theobject by rotation of the inner jaw, and d. said inner jaw defines ahead portion having substantially parallel spaced apart faces with atransversely extending opening therebetween defining spaced apartcutting edges at said faces, B. mounting means within said removal meansfor supporting said inner and outer assembly for relative angulardisplacement relative to each other so as to sever any material of saidobject extending between said jaws as they are moved relative to eachother, said removed material of said object being contained within saidpassage means, C. means for maintaining a suction force in said passagemeans to maintain said object in a substantially fixed position relativeto said jaws, said suction force being applied through said passagemeans to said object, D. means for forming a fluidized suspension ofsaid removed material by supplying a treatment fluid proximate to saidjaws, and E. means for removing said fluidized suspension from saidpassage means, said means including suction means connected to saidpassage means for removal of said fluidized suspension therefrom. 28.Apparatus for performing eye surgery in a human being or other animal invivo, comprising: A. means for progressively removing the lens of theeye from within its capsule, said removal means including passage meansand a pair of jaws connected thereto at proximately one end thereof,said jaws adapted to be moved relative to each other, and B. means formaintaining a suction force in said passage means to retain said lens insubstantially fixed position relative to said Jaws, C. means foreffecting relative movement of said jaws so as to sever the material ofthe lens extending therebetween as they are moved relative to eachother, said removed lens material being contained within said passagemeans, and D. means for supplying a fluid internally to said capsule toprevent collapse thereof during removal of said lens.